Introduction - Tuberculosis in Colorado: From the mile high sanatoria to directly observed therapy

In 1887, a decade after statehood, the Denver Chamber of Commerce announced Colorado to be a mecca for patients with tuberculosis in the belief that dry air, continuous sunshine and lower temperatures were curative. The beginning of the sanitarium movement in 1890's lead to the opening of more than a dozen large sanitariums and more smaller ones in Colorado to serve the influx of individuals arriving in tuberculosis. Between 1908 and 1920 more than 23,000 Colorado residents died of tuberculosis, 10,000 within a year of arrival. The National Jewish Hospital for Consumptives opened in 1899 to provide care for indigents, later becoming an early tuberculosis research center. The concept of direct observations of treatment (DOT) was pioneered at Denver Public Health Department in the 1970s and refined in 1990 as a highly-effective 6-month regimen. Tuberculosis case rates in Colorado have persisted above 2 cases per 100,000 per year for 15 years due to the global burden of tuberculosis; most cases are reported among individuals born in Africa, Asia or Latin America. An average of one Colorado resident is diagnosed with multidrug resistant (MDR) tuberculosis annually, usually in new immigrants. Due to decades of limited tuberculosis research funding, patients with MDR tuberculosis require DOT 5 days a seek for 18-24 months using weak, poorly tolerated regimens resulting in prolonged disability and lost income. The elimination of tuberculosis in Colorado will require tools to improve the diagnosis, treatment and prevention of tuberculosis – tools that will be applicable both globally and locally.